HomeMy WebLinkAboutBLD1990-00153 f3 'TLDING 'ERMIT APPLICATION
Jefferson County Buildil DepartmentlP .O . Box 1220urt Townsend. WA 98368
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LOCATION., i _
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT —31-1-- BLOCK DIVISION TAX NUMBER !
PARCEL NUMBER 1 / 4 SECTION
SECTION / TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
''SINGLE FAMILY U- NEW BUILDING MAIN FLOOR
❑ MOF] I LE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT 1
GARAGE ❑ REPLACEMENT GARAGE 450
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES
SIZE �Jl1 a7 $35
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORMITORY YEAR 4 @ $ 16
NUMBER OF UNITS MAKE 0 @ $8
❑ OTHER SPECIFY ESTIMATED COST OF ,L� a� $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME g-"ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
OIL L OTHER - SPECIFY ' —
❑ REINFORCED CONCRETE ❑ ❑ y
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER �r,
NUMBER OF STORIES r TOTAL LAND AREA `..
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
[j 1 ND 1 V I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM z-
APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EX l ST 1 NG BATHROOtv1
emmow
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY) / A 1, E�`
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
Q NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME ,f MAILING ADDRESS ZIP TEL NO
Oo W. �'1r" ! .. 50 //A c lkVIEW DR, #?-:/`Ditr c t ENa , J, 9g 38S-C461
CONTL-C. jc,Iti{f �G9. / w t>'X j
$'PATE LILhNSF.. O
ARCH 141, . c ._I .2 fR, P , n)e,, _OAT' +t Utid 1414 47Y 37S-6'7
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APPROVED BY PERMIT FEES
BASE FEE INSPECTION
BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE
TOTAL
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
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